The prevalence of human papillomavirus (HPV) infection among Chinese women varies by region, with estimates ranging from 9.6% to 23.6% (1). High-risk HPV (HR-HPV) infections can endure and are strongly associated with the development of several malignancies, including cervical, anal, vaginal, vulvar, penile, and oropharyngeal cancers. Receiving a diagnosis of HR-HPV may have a significant psychological effect on women. Abnormal cytology results are often linked to feelings of sadness, anxiety, trouble sleeping, changes in sexual behavior, and delusional thoughts. Furthermore, women with HR-HPV frequently experience anxiety around the disclosure of their diagnosis, which may threaten their emotional relationship with their partners (2). These results underscore the imperative of attending to the mental health needs of women diagnosed with HR-HPV.

Stigma, which is when people have negative thoughts and feelings about certain health problems, can make it much harder for people to agree to cancer screening and follow-up treatment after a positive diagnosis. This issue is particularly salient in the context of HR-HPV, as the stigma surrounding the condition often stems from its sexual transmission and preventability. Studies conducted in low- and middle-income countries demonstrate that HPV is frequently linked to conceptions of promiscuity, prostitution, and infidelity, resulting in anxieties of blame, social ostracism, and relationship strain (3). Consequently, stigma around HPV has been correlated with reduced vaccine acceptability and delayed participation in cancer screening, notwithstanding the availability of these service.

Psychological resilience, a fundamental concept in positive psychology, is characterized as the capacity to maintain one’s dedication to life objectives and existential purposes notwithstanding challenges (4). People who are more resilient are more flexible, which helps them deal with stressors better and improves their mental and physical health (5). Following an HR-HPV diagnosis, patients with high psychological resilience are more likely to display positive emotions and an optimistic outlook, allowing them to adjust more rapidly and mitigate the emotional distress associated with the infection (6). Emerging evidence supports a link between psychological resilience and reduced stigma (5, 7–9); however, the nature of this relationship in patients with HR-HPV remains unclear. Rumination, by contrast, refers to repetitive, prolonged, and intrusive negative thoughts focused on the self, emotions, personal concerns, and distressing experiences (10). It tends to intensify and prolong negative emotional states such as sadness, anger, anxiety, and depression. Previous studies have shown that rumination plays a significant role in the development of self-stigma among individuals engaged in hazardous drinking (11). To date, however, the potential effect of rumination on stigma in patients with HR-HPV has not been investigated.

Identifying the factors that influence stigma can help healthcare professionals develop targeted strategies to reduce stigma among patients with HR-HPV infection. However, limited research has examined these influencing factors within the context of Chinese culture. Therefore, this study aimed to investigate the current status of stigma and examine the effects of demographic characteristics, disease-related variables, psychosocial factors, psychological resilience, and rumination on stigma in patients with HR-HPV.

Few previous studies have examined the factors influencing stigma in patients with HR-HPV. In this study, we investigated the current status of stigma among HR-HPV patients and identified its influencing factors. Our findings indicate that patients experience varying levels of stigma, with moderate stigma being the most common. Specifically, personal monthly income, recurrent infection, psychological resilience, and rumination were found to be significant factors affecting stigma.

Stigma was originally defined as a social process that categorizes individuals with perceived physical or moral flaws as possessing a “tainted identity,” distinguishing them from those considered “normal” (19). This process can be divided into self-stigmatization and social stigmatization, which interact to create barriers for individuals seeking help (20). Among patients with HPV, stigma arises primarily because the infection is sexually transmitted and preventable (21). Previous studies suggest that HPV-related stigma contributes to low HPV vaccine uptake, even when resources are available (22). Moreover, stigma in patients with HR-HPV acts as a barrier to cancer screening and hinders completion of the continuum of care after a positive screening result (23). In our study, stigma was assessed using SIS, which has demonstrated good reliability across different populations (24). In the present study, 37 patients (18.5%) exhibited low levels of stigma, 152 (76.0%) moderate levels, and 11 (5.5%) high levels. These findings underscore the importance of identifying factors influencing stigma in patients with HR-HPV.

In the present study, multivariate stratified linear regression analysis revealed that personal monthly income, recurrent infection, psychological resilience, and rumination were significant factors influencing stigma. Numerous previous studies have identified economic income as an important factor affecting stigma (25–27). Individuals with higher income levels generally have greater social resources, enabling them to better overcome adversity and experience lower levels of depression and anxiety (4). Conversely, families with low monthly income face more challenges in managing the process of seeking HPV treatment, which may lead to higher affiliate stigma and difficulties in coping (28). Notably, lower income levels have also been negatively associated with awareness of the HPV vaccine (29). Our study found that patients with recurrent HPV infection had higher stigma scores compared to those without recurrence, possibly due to the economic burden and negative emotions associated with repeated infection (30). Given the recurrent nature of HR-HPV infection, accurate and timely screening is essential for effective control. Furthermore, targeted interventions addressing stigma in recurrent patients warrant increased attention.

Psychological resilience refers to the ability to maintain one’s orientation toward existential purpose despite facing adversities and stressful events (4). There is a close relationship between psychological resilience and stigma. Individuals with high psychological resilience tend to accept their disease with a positive attitude, actively confront negative emotions, and experience lower levels of stigma (31). In contrast, those with low resilience often respond to difficulties through avoidance, which can exacerbate the burden of disease and increase stigma (31, 32). Our study confirmed that psychological resilience negatively impacts stigma. Supporting this, previous research has shown that resilience influences the quality of life and depressive symptoms in diabetes patients through stigma (32). Rumination is a form of perseverative thinking characterized by repetitive and unproductive focus on distressing events (33). It intensifies and prolongs negative emotional states such as anxiety and depression (34). Among individuals living with sexually transmitted diseases, rumination can have debilitating effects, especially when combined with stress (35). Rumination and self-stigma may be closely linked, as both involve negative patterns of thinking. However, research on the relationship between rumination and stigma in patients with HR-HPV remains scarce. Our study found that rumination positively influences stigma.

Psychological resilience and rumination independently accounted for 23.4% of the variance in stigma. Our exploratory findings suggest that enhancing psychological resilience and reducing rumination could be effective strategies to mitigate stigma among HR-HPV patients. However, further research is needed to confirm these associations. Interventions such as resilience training—particularly those incorporating mindfulness and cognitive-behavioral techniques—may strengthen resilience (36). For rumination, cognitive behavioral therapy, mindfulness-based interventions, and attentional shifting have demonstrated efficacy in alleviating symptoms (10, 37, 38).

While our study identified personal monthly income, recurrent infection, psychological resilience, and rumination as key factors influencing stigma among HR-HPV patients, it is crucial to consider the potential impact of cultural factors. Traditional Chinese values such as modesty, collectivism, and the emphasis on family honor may shape patients’ perceptions and coping strategies regarding their HR-HPV diagnosis. These cultural norms can contribute to reluctance in disclosing their status, fear of social rejection, and internalized shame, thereby intensifying stigma. Additionally, the stigma surrounding sexually transmitted infections like HR-HPV may be aggravated by cultural beliefs that associate such infections with moral judgments (3). In some societies, HR-HPV is associated with promiscuity or moral deficiencies, hence exacerbating stigmatization (39). Future research should explore the distinct cultural influences on stigma among HR-HPV patients in China and analyze how these cultural factors interact with the socio-demographic and psychological variables revealed in this study.

(1) Enhanced Screening and Follow-Up Programs : ① Personalized Screening Strategies : Because repeated illnesses and a person’s monthly income have a big impact on stigma, healthcare practitioners should tailor their screening and follow-up plans to each patient’s financial situation and history of infections. This may include more frequent screenings and specialized mental health help for people with limited incomes or chronic conditions. ② Resilience Training Programs : Add techniques that help people with HR-HPV be more resilient to their regular care. Mindfulness-based stress reduction, cognitive-behavioral therapy, or group sessions designed to enhance coping methods and foster positive psychological adaptability may constitute effective approaches (40). Psychosocial Support Services : ① Offer counselling and psychotherapy that is easy to receive and not too expensive, and that specifically deals with the mental health problems that come with an HR-HPV diagnosis, such as rumination and stigma. These services must be culturally appropriate and available to patients of all income levels. ② Peer Support Groups : Encourage the establishment of peer support groups for patients to share experiences, exchange coping skills, and offer mutual emotional support. This community-oriented strategy helps mitigate feelings of isolation and reduce stigma (2). Patient Education and Awareness : ① Formulate and execute educational programs that encompass both the medical aspects of HR-HPV and its psychological and social implications. These initiatives should emphasize the significance of early detection, accessible treatment alternatives, and efficient stigma management. ② Media Campaigns : Utilize media venues to enhance public knowledge on HR-HPV, highlighting its treatability and the essential importance of screening. Such campaigns can aid in dispelling misconceptions and diminishing societal stigma associated with the virus.

This study has several limitations. First, the use of a convenience sampling method may have introduced selection bias, limiting the generalizability of our findings to the broader population of HR-HPV patients. Although this approach allowed for efficient recruitment, it may have excluded patients with more severe symptoms or those from different socioeconomic backgrounds. Future studies should consider employing random sampling or other more representative techniques to minimize bias and improve external validity. Second, due to the exploratory nature of this study and the lack of precise effect size estimates in this context, an a priori power analysis was not conducted; future research should incorporate power calculations based on preliminary data or existing literature. Third, the cross-sectional design prevents any causal inferences regarding the associations observed, and longitudinal studies are needed to elucidate causal relationships. Additionally, unmeasured confounding factors such as family history of cancer, social support networks, and previous healthcare experiences may have influenced patients’ stigma perceptions and psychological resilience, and should be accounted for in future research. Fourth, this study did not evaluate negative emotions, which may mediate the impact of stigma, warranting further investigation. Fifth, data were collected via self-report, a method susceptible to subjectivity and potential bias. Sixth, the sample was geographically limited to Liaoning Province, China, which may restrict the applicability of findings; future studies should include more diverse, multi-regional samples. Finally, only female patients were included, excluding males despite evidence that stigma may vary by gender (41); future research should explore these gender differences.

This study indicates that HR-HPV patients recruited from a tertiary hospital in northeastern China experience varying levels of stigma, with moderate stigma being the most common. Personal monthly income, recurrent infection, psychological resilience, and rumination were identified as significant factors influencing stigma in this population. While these findings offer important insights, future research should incorporate more diverse samples across multiple regions and healthcare settings to enhance the generalizability of the results. Moreover, longitudinal studies are warranted to elucidate the causal relationships between these factors and stigma.